Be clear with public on antibiotics and cough, says NICE

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Be clear with public on antibiotics and cough, says NICE

People should be informed more clearly why antibiotics are not required for the treatment of acute cough associated with upper respiratory tract infection and offered advice on alternatives, health professionals and the public have been advised by NICE and Public Health England.

The organisations want people to be made aware of effective self care measures to manage cough symptoms, following the preparation of new draft guidance for antimicrobial prescribing.

Professor Mark Baker, director of the centre for guidelines at NICE said: “We are keen to highlight that in most cases, antibiotics will not be necessary to treat a cough. We want people to be offered advice on alternatives that may help ease their symptoms."

Cough: Explain reason for no antibiotics

The strength of evidence for a range of potential self care measures are examined in the draft guideline, currently out for consultation.

Honey or cough medicines containing pelargonium, guaifenesin or dextromethorpan have some evidence for the benefit of cough symptoms, suggests NICE, and people with acute cough are advised to try these first as a self care measure. Honey can be used for children over one year of age.

Limited evidence suggests that antihistamines, decongestants and cough medicines containing the codeine do not help cough symptoms, says NICE. No evidence for cough medicines containing pholcodine or simple linctus was found. Evidence for echinacea was not found to be robust.

Dr Tessa Lewis, GP and chair of the antimicrobial prescribing guideline group said: "If someone has a runny nose, sore throat and cough we would expect the cough to settle over two to three weeks and antibiotics are not needed.

“People can check their symptoms on NHS Choices or NHS Direct Wales or ask their pharmacist for advice,” she said. “If the cough is getting worse rather than better or the person feels very unwell or breathless then they would need to contact their GP."

Action is needed to reduce antibiotic use said Dr Susan Hopkins, healthcare-associated infection & antimicrobial resistance deputy director at Public Health England. “These new guidelines will support GPs to reduce antibiotic prescriptions and we encourage patients to take their GPs advice about self care.”

However, an antibiotic may be necessary for an acute cough when a person has been identified as being systematically unwell or if they are at risk of further complications for example, people with a pre-existing condition such as lung disease, immunosuppression or cystic fibrosis. People should be made aware of when to seek further advice about their cough.

Acute cough is defined as lasting for less than three weeks, says the guidance. A separate NICE guideline should be followed for children under age five with acute cough and fever.

Consultation for the draft guidance closes on 20 September.

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